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OBJECTIVES: Despite continuous efforts to improve influenza vaccination coverage, uptake among high-risk groups remains suboptimal. We aimed to identify policy amenable factors associated with vaccination and to measure their importance in order to assist in the monitoring of vaccination sentiment and the design of communication strategies and interventions to improve vaccination rates. SETTING: The USA, the UK and France. PARTICIPANTS: A total of 2412 participants were surveyed across the three countries. OUTCOME MEASURES: Self-reported influenza vaccination. METHODS: Between March and April 2014, a stratified random sampling strategy was employed with the aim of obtaining nationally representative samples in the USA, the UK and France through online databases and random-digit dialling. Participants were asked about vaccination practices, perceptions and feelings. Multivariable logistic regression was used to identify factors associated with past influenza vaccination. RESULTS: The models were able to explain 64%-80% of the variance in vaccination behaviour. Overall, sociopsychological variables, which are inherently amenable to policy, were better at explaining past vaccination behaviour than demographic, socioeconomic and health variables. Explanatory variables included social influence (physician), influenza and vaccine risk perceptions and traumatic childhood experiences. CONCLUSIONS: Our results indicate that evidence-based sociopsychological items should be considered for inclusion into national immunisation surveys to gauge the public's views, identify emerging concerns and thus proactively and opportunely address potential barriers and harness vaccination drivers.

Original publication




Journal article


BMJ Open

Publication Date





Adult, Behaviour, Beliefs, Influenza, Perceptions, Vaccine, Adolescent, Adult, Aged, Cross-Sectional Studies, Female, France, Health Policy, Health Promotion, Humans, Influenza Vaccines, Influenza, Human, Male, Middle Aged, Self Report, United Kingdom, United States, Vaccination, Young Adult